儿童右心室双出口的外科治疗

Surgical management of double outlet of right ventricle in children

目的 探讨外科治疗儿童右心室双出口 (DORV)方法及疗效。方法 对收治的 2 8例DORV患者 ,2 6例在体外循环下手术 ,其中 16例心室内隧道构建VSD -AO通道、Rastelli手术 2例、单纯右心室流出道补片加宽术 3例、改良Fontan手术 2例、Glenn手术 1例、肺动脉束带及房间隔缺损扩大术 2例。肺动脉束带术 1例 ,改良Waterson手术 1例。结果 术后早期死亡 8例 ,病死率 2 9%。 1998年至今 19例中死亡 4例。存活的 2 0例至今无死亡。结论 只要诊断明确并掌握好各种术式的适应证 ,DORV的手术病死率必然进一步下降。

Objective To evaluate the efficacy of surgical management of double outlet right ventricle (DORV) in children. Methods 28 chlidren with DORV were treated by operations. Intraventricular baffle was inserted in 16 children while Rastelli procedure was performed in 2 cases. 3 cases underwent simply right ventricular outflow tract enlargement by mean of baffle. Modified Fontan procedure was performed in 2 case and Glenn procedure performed in 1 case. There were also 2 cases of pulmonary artery banding plus ASD enlargement. 1 case was only operated on by pulmonary banding. Modified Waterson procedure was applied to other cases. Results 8 in this group died postoperatively, with the mortality 29%. The remaining 20 children have survived. Conclusion With correct diagnosis and selection of procedure, the mortality of surgical management of DORV will decrease further.